Stroke treatment begins with ER24

Posted on 3 October 2019

ER24 plays a key role in implementing Mediclinic’s cutting-edge stroke protocols, even before their paramedics arrive on the scene.

Strokes are a significant cause of mortality and morbidity in South Africa. However, there is much that can be done to mitigate the effects of a stroke, says Dr Melanie Stander, Emergency Medicine Manager: Mediclinic SA – provided patients receive the right care, at the right time.

Mediclinic has spent the past few years standardising its stroke treatment protocols across all its hospitals in South Africa, instituting new processes and guidelines that ensure each stroke patient receives the best, most appropriate, evidence-based care. And ER24 has played a key role in implementing these protocols within the pre-hospital environment – a key clinical space for fast and effective stroke care.

About 80% of strokes are ischaemic in origin, in that they occur after a blood vessel to the brain has been blocked by a clot, explains Dr Jaclyn Prim, Emergency Centre Head: Mediclinic Vergelegen. In someof these cases, the patients may be candidates for thrombolysis, a technique that uses intravenous medication to break down blood clots that have formed within blood vessels.

However, this process is only effective if the patient receives this treatment within a few hours after the onset of a stroke. “Once a patient has suffered a stroke, the damage has begun,” says Dr Prim. “To halt that process, to restore blood flow to the brain and to prevent lasting brain damage, we need to make a diagnosis and prescribe the correct treatment as soon as possible. The earlier you get into the correct treatment system, the better for your brain.”

Stroke treatment begins on the scene, and every minute matters, agrees Dr Stander. “A person who is having a stroke won’t feel any pain, and there are no first aid interventions that can help in that scenario. So it’s important that bystanders are able to recognise the warning signs, and that they know what to do: call ER24 immediately.”

When you call ER24, you are speaking to an emergency resource officer trained to recognise the signs of a stroke and respond with appropriate urgency. “ER24’s Contact Centres use a specific protocol to identify stroke cases. These cases are treated as priority calls, and the aim is to dispatch the appropriate response as soon as possible.”

In the South African context, Dr Stander explains, describing and distinguishing between stroke symptoms can be a challenge. “ER24’s Contact Centres make use of innovative algorithms to guide emergency calls along the correct clinical pathway to ensure to best response – and with all of our different languages and cultural backgrounds, we need to ensure that these calls are guided in the right way, as quickly as possible.”

ER24 makes use of the international pre-hospital Cincinatti stroke scale (the FAST assessment) to identify patients who have had a stroke, but there may be some patients who present with a stroke that don’t present with the Face, Arm and Speech signs. It’s critical when calling 084124 that the caller identifies their emergency concerns for example a patient that does not wake up following their sleep or even an afternoon nap may also have a stroke. It’s critical our callers alert us to the seriousness of their request. These extra few minutes could be life saving, minutes make moments.

The “trigger” that identifies an emergency call as a stroke case, she says, should occur as early in the call as possible. ER24 staff are trained in asking a series of questions designed to extract relevant information that will trigger the correct pathway – ensuring stroke cases are treated as a priority, and not missed or delayed.

Once ER24 paramedics arrive on the scene, they are trained to verify the signs of a stroke and kick start the stroke clinical pathway, by rushing the patient to the nearest qualifying hospital, says Dr Stander, and their decision-making is guided by what she calls the “hub and spoke” concept. “Hubs are hospitals that can provide the highest level of stroke care – due to the presence of a specialist who utilises advanced imaging to retrieve blood clots in the brain to improve brain blood flow and limit brain damage. Most other hospitals will be considered spokes: they can provide emergency initial imaging and ongoing treatment and can refer you on to a hub hospital as needed.”

Published in Innovation